title: Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures.
abstract: BACKGROUND
  Hybrid procedures combine endovascular and open surgical techniques. We examined utilization rates and ways of performing them more efficiently.
  
  
  METHODS
  Hybrids were selected using codes for femoral endarterectomy, infrainguinal, or aorto-iliac-femoral bypass and angioplasty from Nationwide Inpatient Sample (NIS) data, then categorized as staged, or performed on the same day. Outcomes included utilization rates, total hospital charges, and length of stay (LOS). Confounders of charges and LOS were identified and excluded from final comparisons.
  
  
  RESULTS
  Utilization increased 7% from 2000 to 2004. Univariate associations linked staging to variables included in linear regressions for hospital charges and LOS. Excluding identified confounders from the final subgroup analysis still showed large differences in charges (same-day = $34,206, staged = $60,087) and LOS (same-day = 3 days, staged = 7 days).
  
  
  CONCLUSIONS
  Utilization of hybrids is increasing. Performing hybrids on the same day, if possible, greatly reduces hospital charges and LOS, emphasizing preadmission planning and simultaneous coordination of both portions.
authors.affiliation: Boston VA Healthcare System, Surgical Service (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA. james.ebaugh2@med.va.gov
authors.forename: James L
authors.initials: JL
authors.lastname: Ebaugh
authors.forename: David
authors.initials: D
authors.lastname: Gagnon
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Owens
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Raffetto
mesh_terms: D016009:Chi-Square Distribution; D003131:Combined Modality Therapy / Q000191:economics*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D035002:Lower Extremity / Q000098:blood supply*; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D016012:Poisson Distribution; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000191:economics*